| NPI | 1427336254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29456) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60533) |
| 122300000X Dentist (Licence: LA 6214) | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2020-02-28 |